The authors of the study said it was “somewhat concerning” that 35% of school players said they would continue to play a sport while also having a headache that resulted from a minor concussion. In contrast, only 14% of club players held the same view. While all players were generally knowledgeable about concussion, the study identified “a significant knowledge gap” about chronic traumatic encephalopathy (CTE) – a progressive brain disease linked to repeated concussion. The views and attitudes of over 520 IRFU-registered rugby players from 17 clubs and five schools were surveyed as part of the research. According to an Irish Rugby Injury Surveillance Report, concussion is the most common injury diagnosed in non-professional men’s and women’s rugby clubs in Ireland. Under current IRFU protocols, players should immediately leave a game if they suffer a suspected concussion. Attitudes to concussion The research team from UCC’s School of Medicine and Cork University Hospital said it was evident that the attitude of some players to concussion is still influenced by important matches. The survey revealed that 11% of school players claimed they personally felt a concussed player should return to play during a semi-final game compared to 4% of club players. Similarly, 20% of school players said most athletes would feel a concussed player should resume playing in such a scenario compared to 9% of club players. Overall, the players in Ireland were able to identify concussion signs and symptoms correctly 78% of the time. However, approximately a third of both club and school players incorrectly believed that wearing a scrum cap can prevent a player from getting CTE. The survey also highlighted that 42% of both groups incorrectly believe that symptoms of CTE can be witnessed immediately following a concussion. There are approximately 20,000 registered club players of rugby in the Republic as well as 22,600 school players. The study findings are published in the Irish Journal of Medical Science. They noted that available data indicated a high prevalence of players continuing to play rugby despite being aware of their concussion as well as a tendency to intentionally avoid seeking medical attention after a suspected concussion, particularly during high-pressure or “important” games. Almost 90% of respondents said they had received previous education about concussion. However, only 8% said they have received prior information about CTE, while 76% were largely unfamiliar with the disease. Experience of concussion The survey found 46% of club players had experienced a medically diagnosed concussion at least once in their playing career with 16% recording three or more diagnosed concussions. Among school players, 41% had experienced a medically diagnosed concussion with 4% having three or more diagnosed concussions. Only 26% of club players and 30% of school players never had a suspected previous concussion. The study also found common misconceptions among club and school players including statements relating to experiencing coma. Just 15% of club players and 11% of school players correctly answered that an athlete who gets knocked out after getting a concussion is experiencing a coma. Positive shift The authors of the report said the results, when compared to similar previous studies, suggest there has been a positive shift in the attitudes of rugby players in Ireland towards a safer approach overall. They said such a finding might reflect the IRFU’s ongoing efforts to promote safer practices at both club and school levels. The study recommended that renewed educational efforts should highlight that specific circumstances and perceived importance of a game should not be factors that influence a player’s decision to keep playing after a suspected concussion. It called on the IRFU to integrate up-to-date, evidence-based information on the disease into existing education resources and for coaches and other key personnel to be supported and encouraged to proactively convey this information to players. The study concluded: “Players showed good concussion knowledge, indicating other factors such as the desire to play, performance pressure and the lack of awareness of long-term risk may still contribute to unsafe attitudes.”